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05-0181 (BLCK)�F�a�rw BUILDING & SAFETY DEPARTMENT P.O..Box 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . [0:5-0Q00.0181 Date 1/19/05 Property Address . . . . . . 51315 CALLE KALIMA APN: 770-166-015-3 -000000- Application description WALL/FENCE Property Zoning . . . . . . . MEDIUM DENSITY RES Application valuation . . . . 4333 Owner ------------------------ BUFFIN WILLIAM THOMAS P 0 BOX 134 LA QUINTA CA 92253 Contractor ------------------------ CONTEMPORARY HOMES INCORP P.O. BOX 1141 LA QUINTA CA 92253 WCC: STATE FUND WC: 16764082004 07/01/05 CSLB: 736920 03/31/05 CCC: B --------------------------------------------------------------------=------- Permit. WALL/FENCE PERMIT Additional desc Permit Fee 72.00 Plan Check Fee .00 Issue Date Valuation 4333 QtyUnit Charge Per Extension BASE FEE ,45.00 3.00 .9.0000 THOU, BLDG 2,001-25,000 27.00 ---------------------------------------------------------- ------ Special Notes and Comments 130 L.F. 6' BLOCK WALL, 50 L.F. 5' COURTYARD WALL, BOTH CITY STANDARD Fee summary Charged Paid Credited Due -- - - - - - - - - - - - - - ------ - - -------- - - - ------- - - - - ----- - - - - - - Permit Fee Total 72.00 .00 .00 72.00 Plan Check Total .00 .00 .00 .00 Grand Total 72:00 .'00 .00 72.00 I JAN 2 4 2005 CITY pF LA QUINTA P.O. BOX 1504 78-495 CALLS TAMPICO �� FAX (760) 777-7011 VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: LI) S' /&/ Date: Applicant: Architect or Engineer: Applicant's Mailing Address: r10 c�<F VN 5�9h Architect or Engineer's Address: / Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions ofpt 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. 3 n Z— O /�Cicense Cla s icense No. OWNER43UILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): U I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , B.& P.C. for this reason Date WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensations' aance carrier and p0JcV0tr?er61e. O Carrier P/ olicy Number dt yZ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date icant t• LAI 4-1^ WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lenders Address a' APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work Is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agree II, defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the eing pe ed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes nut void if wor5ag 'f c ced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit tocaa anon. I certify that I have read this application and state that theaboe information is a comply with all city and county ordinances and state laws relating to building c_onstru�ction, and ereby auth� r�entatives�s county to enter abov,tioned property for inspection purposes. ' ignat6 ure (Applicant or Agent): av 78-495 CALLE TAMPICO LA QUINTA, CA 92253 1760) 777-7075 4 - APPLICATION FLOOD PLAIN DEVELOPMENT PERMIT BUILDING SITE LOCATION FLOOD ZONE "AO' - DEPTH 1 st _ '2 1 c Com' (e- (k0.' i �� COMMUNITY- PANEL NUMBER l J l J !� 060709 0005 B Lo.:Qv� ,��" CP1 \Z -Z S� Map Revised: 8/19/1991 APPLICANT INFORMATION SECTION c i APPLICANT NAME APPLICANT �. toy, 3� ADDRESS (MAILING ADDRESS, NOT THE BUILDING SITE) La, GtV % '.� C A \ � 15 3 DAYTIME TELEPHONE NO. INSTRUCTIONS 1. A Flood Plain Development Permit is required by LQMC Section 8.11.040(A)• The Applicant should complete the Applicant Information portion of this application and submit it to the Engineering Department along with the required documentation noted hereon at the same time the Precise Grading Plan is submitted to the Building and Safety Department "for plan checking. 2. Documentation required for STEP 1 OF 2 APPROVAL prior to receiving clearance for Building Permit issuance • Copy of the proposed Precise Grading Plan for review and approval containing all information required by the checklist shown on the back of this application. 3. Documentation required for STEP 2 OF 2 APPROVAL prior to receiving Flood Plain Development Permit approval. Note, this approval occurs after forms for the lowest habitable floor are set and before the Building & Safety Department authorizesifoundation construction. • Submit a completed FEMA "Elevation Certificate" form to the Engineering Department. • Submit 95% relative density soils compaction certification to the Engineering Department. STEP 1 OF 2 APPROVAL STEP 2 OF 2 APPROVAL The Precise Grading Plan submitted for this application has been All requirements have been satisfied. This Flood Plain reviewed and found to contain all data required to satisfy the Development Permit is approved. requirements of LQMC 8.11 The proposed dwelling is eligible to receive a building permit upon satisfying all other Building & Safety Department requirements. 4-1; Z y 0 AUTHORIZED SIGNATURE DA AUTHORIZED SIGNATU DATE La Ouinta Engineering Department La Quinta Engineering Department FILE: Upon Step .2 approval, original goes in "flood Plain Development Permit" file; copy goes to Applicant F090 REV -2 7100